1740506963 NPI number — DR. ARUN GOPAL M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740506963 NPI number — DR. ARUN GOPAL M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GOPAL

Provider First Name:

ARUN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1740506963

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/16/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4140 W 190TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TORRANCE

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

90504-5513

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

18321 CLARK ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TARZANA

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

91356-3501

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

818-881-0800

Provider Business Practice Location Address Fax Number:

310-423-8441

Provider Enumeration Date:

04/13/2010

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  Q6508 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: A152047 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: A152047 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 358313004 . This is a "MEDICAID ARC ROT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 358313001 . This is a "MEDICAID SAIMS ROT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 358313003 . This is a "MEDICAID ARC TRAVIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 358313002 . This is a "MEDICAID SAIMS TRAVIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 503332YKXY . This is a "MEDICARE ARC ROT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 503332YKXV . This is a "MEDICARE ARC TRAVIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 503332YLP1 . This is a "MEDICARE SAIMS TRAVIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 503332YLP2 . This is a "MEDICARE SAIMS ROT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".